Kristian Chrz, David Hoskovec, Zdeněk Krška, M E Dämmrich, Pavol Klobušický
BACKGROUND Spermatic cord liposarcoma is a rare adipocytic malignancy, with fewer than 200 cases described worldwide. Due to its rarity and nonspecific clinical presentation, it is frequently misdiagnosed as more common inguinoscrotal conditions such as hernia or hydrocele. Histologically, liposarcomas comprise several subtypes with varying prognoses. Accurate diagnosis is often challenging preoperatively and typically relies on imaging and definitive histopathological evaluation. CASE REPORT We present the case of an 87-year-old man with a progressively enlarging, painless mass in the left inguinoscrotal region, significantly impairing mobility. Computed tomography revealed a large, well-circumscribed mass originating from the spermatic cord, with both cystic and fatty components, along with a concurrent inguinal hernia and hydrocele. No metastatic spread was identified. The patient underwent complete surgical excision of the tumor with simultaneous orchiectomy and inguinal herniotomy. Histopathological analysis confirmed a well-differentiated liposarcoma (G1) with negative surgical margins (R0 resection). Given the patient's advanced age and comorbidities, no adjuvant therapy was indicated. The postoperative course was uneventful. CONCLUSIONS Spermatic cord liposarcoma remains a diagnostic and therapeutic challenge due to its rarity and clinical resemblance to benign conditions. Radical surgical excision with negative margins is the cornerstone of treatment and offers favorable outcomes, particularly in well-differentiated, low-grade tumors. However, the high rate of local recurrence necessitates long-term follow-up. The role of adjuvant therapies such as radiotherapy or chemotherapy remains unclear and should be individualized based on tumor characteristics. Increased awareness and reporting of such cases are essential to improve diagnostic accuracy and optimize management strategies.